Loss, Grieving And Death

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What is loss?

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loss ia an actual or potential situation in which something that is valued is changed, no longer available, or gone.

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experiences of losses?

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loss of body image, a significant other, a sense of well-being, a job, personal possessions, beliefs, or a sense of self.

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2 types of losses?

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actual and perceived

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actual loss

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can be recognized by others

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perceived loss

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experienced by one person but cannot be verified by others

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phsychological losses arwe often perceived lossess in that they are not directly verifiable.

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example; a women leaves her job to take care of her childre may perceive a loss of independence and freedom.

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anticpatory loss

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is experienced before the loss actually occurs.ex; a womans husband is dying and may experience actual loss in anticipating his death.

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situational losses

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loss of job, the death of a child, loss of functional ability b/c of acute illness or injury

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developemental losses

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losses that occur in the process of normal development- such as departure of grown children from the home, retirement from career, death of aged parents-can be to some extent be anticpated and prepared for.

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sources of loss

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a body part, physiologic function or psychologic attribute, separation from an accustomed environment, loss of loved or valued person

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loss of aspect of self changes

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changes a persons body image, even if not obvious

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old age may experience many losses

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ex- employment, usual activities, independencce, health, friends, and family

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grief

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is the TOTAL RESPONSE to the EMOTIONAL EXPERIENCE related to loss. manifested in thoughts, feelings, and behaviors associated with overwhelming distress or sorrow.

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Bereavement

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is the SUBJECTIVE RESPONSE experienced by the surviving loved ones after the death of a person with whom they have shared a significant relationship.

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Mourning

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is the BEHAVIORAL PROCESS through which grief is eventually resolved or altered; often influenced by culture, spiritual beliefs, and custom.

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symptoms that may accompany grief

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anxiety, depression, dizziness, weight loss, difficulties in swallowing, vomiting, fatigue, headaches, fainting, blurred vision, skin rashes, excessive sweating, menstrual disturbances, palpitations, chest pain, and dyspnea.

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normal grief

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may be abbreviated grief or anticpatory grief.

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abbreviated grief

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is brief but genuinly felt

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anticipatory grief

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experienced in advance of the event.

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disenfranchised grief

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occurs when a person is unable to acknowledge the loss to ther persons.

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dysfunctional grief

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unhealthy grief- may be unresloved or inhibited

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factors that affect dysfunctional grief

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include a prior traumaatic loss and the circumstances of the present loss, family or cultural barriers to the emotional expression of grief

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unresloved grief

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is extended in length and severity- may have difficulty expressing the grief, may deny the loss or may grieve beyond the expected time.

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dysfunctional grief mau be inferred by

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failing to grieve, fails to visit grave, becomes symptomatic of loss during holidays, anniversaries, develops guilt, may consider suicide, unable to discuss the deceased, relationaships with fmaily and friends worsen.

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factors contribute to unresolved grief

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a perceived need to be brave and in control, multiple losses, uncertainty about the loss of someone, lack of support system

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stages of grieving KUBLER-ROSS

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denial, anger, bargaining, depression, acceptance

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ENGEL

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shock and disbelief, developing awareness, restitution, resolving the loss, idealization, and outcome

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SANDERS

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shock, awareness, conservation/withdrawal, healing, and renewal

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The nuse assess the grieving client for what?

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to determine the phase or stage of grieving.

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Physiologically, the body responds to a current or anticipated loss with?

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stress reaction. The nurse can assess the clinical signs of this response.

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normal manifestations of grief

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verbalization of the loss, crying, sleep disturbance, loss of appetite, and difficulty concentrating.

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characteristics of dysfunctional grieving

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extended time of denial, depression, severe physiologic symptoms, or suicidal thoughts.

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nursing assessment of the client experiencing a loss include three major components

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nursing history, asssessment of personal coping resources, and physical assessment.

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nursing diagnosis related to grieving

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anticipatory grieivng
dysfunctional grieving
interrupted family processes
impaired adjustment
risk for loneliness

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planning goals for clients who are grieving the loss of body function or a body part

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to adjust to the changed ability and to redirect both physical and emotional energy into rehabilitation

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planning goals for clients who are grieving the loss of a loved one

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are to remember that person without feeling intense pain and to redirect emotional energy into ones own life and adjust to the actual or impending loss.

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skills most relevant to situations of loss and grief

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are attentive listening, silence, open and closed questioning, paraphrasing, clarifying and reflecting feelings, and summarizing.